What is the Mediterranean Diet?

Over the last thirty years the media has disseminated literally thousands of columns on nutrition information and how to eat healthy. The problem is that there have been so many different (and often over-simplified) messages: avoid fat, avoid trans-fats, eat whole grains, avoid all carbohydrates, all meat is bad, all meat is good, sugar is bad, don't eat anything white, only a vegan diet is healthy, we should eat like Neanderthals....

Some of that information is in fact mis-information: it comes from fad diets which are generally based on faulty science at best and much more often based on outright myth and pseudoscience. Add to the confusion the fact that nutrition science has been evolving in the last few years, and that health messages that are indeed founded on the best science available still do change over time. Between this and silly fad diets it can be hard to know what to believe.

That's the bad news.

The good news is that there has been a tremendous amount of excellent research about diet and nutrition published in the last decade. We now have a great understanding of what works from studies of the Mediterranean style diet. "Mediterranean" simply refers to the people who live on the Mediterranean Sea, whose diets are higher in fruits and nuts, vegetables, legumes (beans and peas), and whole grains and cereals. They consume less red meats and poultry than we Americans do, and they eat more fish. They eat some dairy products, although much of the dairy is in the form of cultured products like cheeses and yogurt rather than drinking milk. That lower intake of poultry and red meats is coupled with a moderate consumption of alcohol, which is usually wine and drunk most often with meals. Olive oil is their main source of dietary fat, and they use far less of the more highly saturated fats like butter and lard.

The best way for you to think about this is to focus on these ingredients and that style or pattern of eating and not specific Mediterranean recipes. This style of eating and these ingredients have formed the basis for Dr. Gourmet recipes for years, and for the most part it adds up to fewer calories and better quality foods. That is, in essence, what I like to describe as a "MedAmerican" diet: using the principles of the Mediterranean diet and applying them to the American kitchen by translating the recipes that you know and love into versions that taste just as good but are better for you. You'll be surprised at how good my healthier versions taste - I promise.

Before the year 2000 there had been a number of studies to suggest how healthy the Mediterranean Diet was, and in 2003 Antonia Trichopoulou and her colleagues reported on a large study that examined over 22,000 healthy adults in Greece. They found that those who more closely followed a Mediterranean-style diet had a significant reduction in their risk of death from heart disease and cancer. (NEJM 2003;348:2599-2608).

While there had been other studies, this was a much larger and more exhaustive look, with the researchers following participants over time. Dr. Trichopoulou and her colleagues analyzed the diets of those in the study for a year prior to the beginning of data collection. They then looked at nine dietary components of a Mediterranean diet. A value was assigned of either 1 or 0 for each dietary category: fruits and nuts, vegetables, legumes, whole grains and cereals, meat and poultry, fish, dairy, dietary fats, and alcohol. If a participant was found to have eaten a diet more favorably in each of the nine dietary components, they received a point in each of those categories. The maximum score for a perfect Mediterranean diet would be 9 and a score of 0 would indicate a more Western diet pattern. They also issued a lifestyle questionnaire that recorded physical activity.

The results were pretty amazing. Quite simply, those who had better scores lived longer and were healthier.

The best part is that small changes have a big effect. After analyzing the data, the researchers noted that a two point improvement (say from 5 to 7) in a Mediterranean Diet Score resulted in a 25% reduction in death from all causes. This would mean, for example, that by simply eating more vegetables and legumes you could markedly improve your health and live longer.

Your Mediterranean Diet Score

What about those 9 components of the Mediterranean diet? How has this been used in research and what does it mean for you?What makes up the Mediterranean diet score?

That study of over 22,000 Greeks determined a threshold amount for each component of the Mediterranean Diet. The following list details those thresholds and you can calculate your own diet score based on these amounts.

It is pretty simple. The scores have been adjusted for a 1,500 calorie per day diet for women and 2,000 calories for men. For instance, if you are a woman and consume more than 9 ounces of veggies by weight per day, on average over a week, you score one point. Eat less than that on average and you get zero. The best overall score is a 9 and the worst a zero.

Work through these 9 sections and see how you score. Keep track of your food intake for a week and score yourself on the average over the week. Even better, you'll find that keeping a simple food diary can help you identify places where you can improve your score.

1. If you are female, do you eat more than 9 ounces of vegetables per day (11 ounces for men)?

Score:
1 point for greater than the optimum ratio of greater than 1.6 to 1 for healthy fats:less healthy fats.
0 point for less than the optimum ratio of greater than 1.6 to 1 for healthy fats:less healthy fats.

Conclusion and Score

There is no passing or failing grade for this test, but the higher your score, the better. A perfect Mediterranean style diet would be a score of 9 and if you're living on snack food and soda, it is likely your score will be closer to zero.